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Cognitive workload of health technologies

New health technology will only deliver if it is well designed. Poor usability can impede adoption, reduce efficiency and even increase risks to patients.

Hospitals across the world are moving to electronic health records, but adapting to using any new system can be a challenge. In the high risk environment of medicine, increases in cognitive workload while transitioning to a new system can be dangerous.

Among GPs, poor usability is a common complaint about record systems and increased cognitive workload may impact on user satisfaction, user fatigue, clinical productivity and safety.

One of our alumni, Dr Lacey Colligan, led a study in the United States following paediatric nurses on a ward and a neonatal intensive care unit as they coped with the introduction of a new electronic health record system. Even though multiple measures were put in place to ease the transition, including double staffing for two weeks, the study, conducted with Dr Henry Potts and others, saw a large increase in cognitive workload. Such an increase is a cause for concern as it could lead to an increase in errors. It took about ten shifts for cognitive workload to return to baseline.

Dr Ferran Ariza, a London GP, with Dr Henry Potts (UCL Institute of Health Informatics)  and Prof Dipak Kalra (UCL Institute of Health Informatics), looked at the cognitive demands of GP record systems in the UK, covering the main systems currently in use including: 

  • EMIS
  • SystmOne
  • INPS Vision
  • iSoft Synergy
  • Microtest Evolution

There was no statistically significant difference between the systems, which may come as a relief to the suppliers! However, certain tasks were identified as making greater demands, notably including repeat prescribing. This suggests that there is room for improvement in the design of some aspects of GP systems.

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